Narayanan Kumar, Zhang Lin, Kim Candice, Uy-Evanado Audrey, Teodorescu Carmen, Reinier Kyndaron, Zheng Zhi-Jie, Gunson Karen, Jui Jonathan, Chugh Sumeet S
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (K.N., L.Z., C.K., A.U.E., C.T., K.R., S.S.C.).
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (K.N., L.Z., C.K., A.U.E., C.T., K.R., S.S.C.) Shanghai Jiaotong University School of Public Health, Shanghai, China (L.Z., Z.J.Z.).
J Am Heart Assoc. 2015 Mar 11;4(3):e001654. doi: 10.1161/JAHA.114.001654.
Obesity has been associated with significantly greater risk of sudden cardiac death (SCD); however, identifying the obese patient at highest risk remains a challenge. We evaluated the association between QRS fragmentation on the 12-lead electrocardiogram and SCD, in obese/overweight subjects.
In the ongoing prospective, community-based Oregon Sudden Unexpected Death Study (population approximately 1 million), we performed a case-control analysis, comparing obese/overweight SCD victims with obese/overweight controls from the same geographic region. Archived ECGs prior and unrelated to the SCD event were used for cases and all ECG measurements were assessed in blinded fashion. Fragmentation was defined as the presence of RSR' patterns and/or notching of the R/S wave in at least 2 contiguous leads. Analysis was limited to ECGs with QRS duration <120 ms. Overall prevalence of fragmentation was higher in cases (n=185; 64.9±13.8 years; 67.0% male) compared with controls (n=405; 64.9±11.0 years; 64.7% male) (34.6% versus 26.9%, P=0.06). Lateral fragmentation was significantly more frequent in cases (8.1% versus 2.5%; P<0. 01), with non-significant differences in anterior and inferior territories. Fragmentation in multiple territories (≥2) was also more likely to be observed in cases (9.7% versus 4.9%, P=0.02). In multivariable analysis with consideration of established SCD risk factors, lateral fragmentation was significantly associated with SCD (OR 2.84; 95% CI 1.01 to 8.02; P=0.05).
QRS fragmentation, especially in the lateral territory is a potential risk marker for SCD independent of the ejection fraction, among obese/overweight subjects in the general population.
肥胖与心源性猝死（SCD）风险显著升高相关；然而，识别出风险最高的肥胖患者仍是一项挑战。我们评估了肥胖/超重受试者12导联心电图上QRS波碎裂与SCD之间的关联。
在正在进行的基于社区的前瞻性俄勒冈州猝死意外研究（人口约100万）中，我们进行了病例对照分析，将肥胖/超重的心源性猝死受害者与来自同一地理区域的肥胖/超重对照者进行比较。将与心源性猝死事件无关的存档心电图用于病例分析，所有心电图测量均采用盲法评估。碎裂定义为至少2个连续导联中存在RSR'模式和/或R/S波切迹。分析仅限于QRS波时限<120 ms的心电图。与对照组（n = 405；64.9±11.0岁；64.7%为男性）相比，病例组（n = 185；64.9±13.8岁；67.0%为男性）的总体碎裂患病率更高（34.6%对26.9%，P = 0.06）。病例组的侧壁碎裂明显更常见（8.1%对2.5%；P<0.01），前壁和下壁区域无显著差异。病例组也更可能观察到多个区域（≥2个）的碎裂（9.7%对4.9%，P = 0.02）。在考虑已确定的心源性猝死危险因素的多变量分析中，侧壁碎裂与心源性猝死显著相关（OR 2.84；95%CI 1.01至8.02；P = 0.05）。
在一般人群的肥胖/超重受试者中，QRS波碎裂，尤其是在侧壁区域，是独立于心室射血分数的心源性猝死潜在风险标志物。
